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9/01/2010

The thin line between sanity and the safety net

Driving to the post office today, I noticed that one of our neighborhood schizophrenics was out on the sidewalk, but not in her usual spot. A very slight and petite woman, her clothing is usually augmented with multiple plastic grocery bags. She carries many more such bags with her, apparently having failed to obtain a grocery cart. She typically lays out multiple scraps of paper on the sidewalk and in the gutter. Driving by, you can see that they are covered with her writings, which are not in an English character script. Sometimes she holds up a scrap or two of paper for display while talking to cars or whomever, or to no one at all.

It’s an ordinarily sad sight, but she appears in no distress. She does not have the sun-leathered skin or the grime encrusted clothing of a homeless person.

Today, I felt there was reason to worry. She was in the shade, but it was still just the noon hour in Sacramento and the thermometer was already close to 100.

On my way back, she was in the middle of the street with her plastic bags strewn about. It’s a four lane street with a turn lane in the center. A man was near her, gesturing for her to return to the sidewalk while speaking on his phone, presumably calling 911. There was nothing more to be done. Either she would find her way back to the sidewalk or the Sheriff’s cruiser would soon arrive.

I had another stop to make. When I came out, she was out of traffic and back in her usual spot, on the corner in the sun. I wondered how she could tolerate the heat while encased in plastic.

The woman is obviously not sane (I’m not using that term in its legal sense). Had the Sheriff arrived, there is a good chance she would have ended up in the back of the patrol car. It would be nice to think that she would then get a ride to County Mental Health to enjoy a 72 hour respite from her daily toils.

That is not, however, what would have happened. Our clinics are more or less closed. Those people still capable of getting help on their own are going to the hospital emergency room. The other day in Sacramento, two such patients were put together in the same room to wait, and there was a fight or an assault or whatever.

Those who are incapable of seeking treatment on their own are now taken to Jail. They are always good for some misdemeanor charge that can be dismissed after they have been seen by the Jail Psych service. But if they struggle, resist or cause problems while being “arrested,” there is inevitably a more serious charge to keep them in Jail and to be resolved by the Courts.

Once that person is in Jail, there is a good chance that I will be appointed to see them. No, my task as a psychologist will not be to help them. I will be paid to determine whether or not they are competent or sane enough to navigate the Court system. Often, that’s not an issue. But there are a lot of times when these people can’t find their way out the door, even when it’s opened for their release.

Today, in too many parts of California, there is no fine line between sanity and the safety net because there just is no safety net there at all.

We let preventable problems get worse and then deal with them where it costs the most.

When we fail to spend on fundamental quality of life services like mental health (and the list goes on), it just costs us more in the long run. The way I think about it, if your roof has a hole in it, you don’t save any money by letting the rain come in.

The County can’t spend and the State can’t spend because they don’t have any money.

The Republican Party in California says that there will be no new taxes of any kind. They actually speak for a lot of people, and because of the vote requirements for a budget, they can block almost anything.

This is not good. It is not good to have a mentally incapable woman at risk for entering the criminal justice system only because she wasn’t given a bit of psychological help when it was needed.

For a community, it is a moral as well as a practical failure. In a community, if your safety net has a hole in it, you don’t save money by letting people fall through. You would have to be insane to think that you would.

People don’t like taxes? They don’t like fees? They don’t want to spend money?